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Des.n Izss APPLICATION FOR PLUMBING PERMIT
'
d' DIVISION OF BUILDING AND SAFETY 1'
Deportment of County Engineer
County of Los Angeles
WM. J. FOX. COUNTY ENGINEER BUILDING. dD �l.L O�OG!�
CASSATT D. GRIFFIN. SUPT OF BUILOESS 15 07 GINO - AODR
FOR APPLICANT TO FELL IN NEARS TY Tiry �7
CROSS ST.
OWNER /ir TG���
DISTRICT NO. .GROUP. ZONE READY FON INSPECT ION
MAIL I I
ADDRESS
INDUSTRIAL -
CITY �/rlP1.X /T TEL. NO. WASTE APPROVAL
PLUMBER �46hioo 4. p�6 �/ /As INSPECTION RECORD
ADDRESS 1`D6';(
CITY C/F/y✓�rTE TEL. NO: Fi.'rA/.p v{�G'S✓
-
LICENEjE NO. ��✓�V A/ �� ��t\ u Com_ I ♦q `
NUMBER TYPE OF FIXTURE O R ITEM ¢x .AFEE C`
WATER CLOSET (TOILET)
BATH TUB _L0 - l'
SHOWER Q - -
LAVATORY (WASH BASIN). _ O
KITCHEN SINK Q
DISHWASHER. -
LAUNDRY TUB OR TRAY
CLOTHES WASHER -
TOTAL NO. . ® ' O APPROVALS -
GAS SYSTEM OUTLETS @ 1.00 Q - DATE INSPECTOR'S SIGNATURE /
. �S
WATER HEATER @ 1.00. U UNDER SLAB WORK
ROUGH PLUMBING L,
PERMIT s. 1 00 -
GAS PIPING
TOTAL FEE. �� UD GAS VENT '
I HEREBY ACKNOWLEDGE THAT I .HAVE READ THIS APPLICATION .HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND-AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING.FIXTURES
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF .UTILITY CO. NOTIFIED
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL P OPER
SIGNATURE
OF PERMITTEE FINAL P
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
(A[;o5 6 5 5�, FEB 28 3 1 1 .00 ID
- _ r BY
_ DEPUTY